what can I advise?

[Macha McDonald]

Hiya.  The OB left to go overseas.  This town (pop 4,500aprox) has a problem with getting GPs to stay here....something else we are addressing, along with the problem of having no bulk billing GPs.  So, the OB left, and now there is a new doc taking her place, but he is still unsure if he wants to pay the insurance.  Is it possible (legal may be more appropriate...we all know its possible) to have birth services without access to an OB?  Or is it compulsory to have an OB.  Shepparton is the nearest centre, and most women are going there to have their babies.  It is at least 45 minutes away to Numurkah, or Yarrawonga to have your baby.  One of the main things that needs to be addressed is the old fashioned policies here.  There is no early release program, low breastfeeding rates...the breast feeding clinic comes once a fortnight, but is more of an accursed controlled crying centre.....and high intervention.  There is no anesthisetist (?wow....I know my spelling is way out), so epidurals are not an option(this is a good thing).  Women are transferred to Shepparton for epidurals.  That is about all I know.  There is one lady here, 20 weeks preg, exploring unassisted birth.  That is how bad it is.  Cobram is like a small centre for the surrounding small towns.  The closest large centre is an hour away, and it is unacceptable that there is no way a lady can give birth here, unless unassisted.  We intend to try and do something about it. Macha. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of PJ_WM_HERMEL Sent: Wednesday, 27 February 2002 1:05 PM To: [EMAIL PROTECTED] Subject: Response to: what can I advise? Hi Macha I am a midwife from a remote rural town in SA that has had no midwifery or obstetric service for just over 12 months now.  The women (about 70 of them) have to travel a minimum of one hour to get to one hospital that does have these services, though most travel 400 - 800 kms away at least 2 weeks before their due date.  There is a huge emotional and financial cost to these families.  I am currently working with another midwife to present to our hospital board an option of midwifery model of care (like caseload, with 3-4 midwives working with our local GP's).  Our hospital and management have been fantastic in helping us come up with this proposal.  I can understand your dilemma, we are very lucky that our hospital runs one of our medical centres which enables us to work well with the GP's.  We have a very unique situation over here with fantastic benefits and opportunities for midwives.  One of our problems with our model is that we do not have the midwives to start it as yet. I am unsure why your services stopped in the first place perhaps you need to look at this first as our own services were suspended due to not having enough GP's with obstetric privelages, we have now got these but our midwives numbers have dropped.  A great resource to look at different models of care which may help making your mind up is 'Establishing Models of Continuity of Midwifery Care in Australia' by Homer C, Brodie P, Leap N, 2001.  It has a table of contacts for different programs right around Australia.  I can't recommend it enough, it has been of enormous benefit in working out a model for us. Regards Wendy Hermel